Percutaneous thrombus extraction device and method
A percutaneous thrombus extraction device for removing a thrombus from within a blood vessel includes a flexible outer sheath defining a first passage between a proximal end and a distal end. An inner sheath is movably positionable within the first passage. The inner sheath defines a second passage between a proximal end and a distal end. The inner sheath is moveable in a radial direction between a collapsed configuration and an expanded configuration along a length of the inner sheath defined between the proximal end and the distal end. A catheter is movably positionable within the second passage, and has an expandable body at a distal end portion of the catheter. The expandable body is movable between a collapsed configuration and an expanded configuration.
This application is continuation application of U.S. patent application Ser. No. 16/055,385, which was filed on Aug. 6, 2018, which was is a divisional application of U.S. patent application Ser. No. 14/243,217 which was filed on Apr. 2, 2014, and is now U.S. Pat. No. 10,039,560 which was a divisional application of U.S. patent application Ser. No. 12/950,771, filed Nov. 19, 2010, and is now U.S. Pat. No. 8,801,736, which are incorporated herein by this reference.
BACKGROUNDThe subject matter described herein relates generally to a device suitable for extracting emboli, such as thrombi, from within a blood vessel and, more particularly, to an extraction device configured for percutaneous vascular introduction to remove a clot or thrombotic material without surgical intervention.
Standard treatment for thrombo-embolic disease or blood clots (e.g., embolism to the superficial femoral artery (“SFA”) or treatment of dialysis access thrombosis) includes utilizing a embolectomy catheter, such as a Fogarty catheter including an inflatable balloon near a distal tip of the catheter to facilitate removal of emboli and thrombi (e.g., a blood clot) from within a blood vessel.
In the case of SFA, the patient undergoes general anesthesia in the operating room, a surgical incision is made and the artery is cut open by the surgeon. The catheter is inserted and pushed across the embolism or thrombus, the balloon is inflated to match a diameter of the artery and pulled back until the thrombus and the balloon are pulled outside of the body through the incision. This procedure requires general anesthesia and a surgical approach. Thus, the procedure is risky to the patient and very costly, requiring a hospital stay.
BRIEF DESCRIPTIONIn one aspect, a catheter that includes a body portion having a distal end and a proximal end. The body portion defines a passage between the distal end and the proximal end. A first expandable body is positioned at a distal end portion of the catheter that is movable between a collapsed configuration and an expanded configuration. A second expandable body is positioned at an opposing proximal end portion of the catheter. The passage provides fluid communication between the second expandable body and the first expandable body. The second expandable body is movable between a collapsed configuration and an expanded configuration.
In another aspect, an extraction device includes a flexible outer sheath defining a first passage between a proximal end and a distal end, and an inner sheath movably positionable within the first passage. The inner sheath defines a second passage between a proximal end and a distal end. The inner sheath is movable in a radial direction between a collapsed configuration and an expanded configuration along a length of the inner sheath defined between the proximal end and the distal end. The inner sheath is self-expandable to the expanded configuration to conform to an inner surface of the blood vessel.
In yet another aspect, a system includes a flexible outer sheath defining a first passage between a first proximal end and a first distal end, and an inner sheath movably positionable within the first passage. The inner sheath defines a second passage between a second proximal end and a second distal end. The inner sheath is movable in a radial direction between a collapsed configuration and an expanded configuration along a length of the inner sheath defined between the second proximal end and the second distal end. At least a portion of the inner sheath contacts an inner surface of the blood vessel when the inner sheath is extended from the first distal end and in the expanded configuration.
The embodiments described herein provide an extraction device that can be introduced into a blood vessel percutaneously for extracting emboli or thrombi from within the blood vessel. The minimally invasive percutaneous introduction reduces or minimizes trauma to the patient without the need for general anesthesia or hospitalization, which leads to improved patient comfort and safety, as well as major savings to the health care system. Although the embodiments have been described herein with relation to extracting emboli or thrombi from within a blood vessel in the patient's cardiovascular system, it should be apparent to those skilled in the art that the extraction device described herein may be suitable for other extraction procedures, such as removing stones from biliary tubes, for example.
A flexible inner tube or sheath 32 is movably positionable within passage 24 defined along a length of outer sheath 22. In a collapsed or partially collapsed configuration, inner sheath 32 is freely movable through passage 24 defined through outer sheath 22 to position inner sheath 32 proximate thrombus 14. Inner sheath 32 has a suitable outer diameter to facilitate reciprocal movement of inner sheath 32 within outer sheath 22. Inner sheath 32 defines a passage 34 between a proximal end (not shown) and an opposing distal end 38 of inner sheath 32. Inner sheath 32 is moveable or expandable in a radial direction between a collapsed configuration and an expanded configuration substantially along an entire length of inner sheath 32 defined between the proximal end and distal end 38. Unlike conventional expandable sheaths that expand only at a distal end portion, inner sheath 32 is expandable along substantially the entire length of inner sheath 32 such that an inner cross-sectional area of passage 34 increases along the length of inner sheath 32 as inner sheath 32 is expanded. Because the cross-sectional area of passage 34 increases along an entire length of inner sheath 32, relatively larger emboli, thrombi, and/or other occluding particles can be easily removed from within blood vessel 12 utilizing inner sheath 32, as described herein.
Suitable flexible materials for use in constructing inner sheath 32 may include, without limitation, the materials suitable for constructing outer sheath 22 as set forth above. In one embodiment, inner sheath 32 is self-expandable in a radial direction from an initial collapsed configuration, which facilitates movement or translation of inner sheath 32 through outer sheath 22, to the expanded configuration, wherein inner sheath 32 has a diameter corresponding to an inner diameter of blood vessel 12 that is larger than a diameter of inner sheath 32 in the collapsed configuration. In the expanded configuration, inner sheath 32 substantially conforms to the inner surface of blood vessel 12.
In one embodiment, with inner sheath 32 positioned proximate thrombus 14, inner sheath 32 expands in a radial direction along a length of inner sheath 32 to contact the inner surface of blood vessel 12 as outer sheath 22 is extracted from within blood vessel 12. In one embodiment, outer sheath 22 is at least partially extracted from within blood vessel 12 to allow inner sheath 32 to expand in a radial direction along at least a portion of the length of inner sheath 32. In a particular embodiment, outer sheath 22 is completely extracted from within blood vessel 12 and removed through the incision to allow inner sheath 32 to expand in a radial direction along the entire length of inner sheath 32. As inner sheath 32 extends from distal end 28 of outer sheath 22, inner sheath 32 in the expanded configuration contacts the inner surface of blood vessel 12. In an expanded configuration, a distal end 40 of inner sheath 32 is configured to retain thrombus 14 to facilitate removal of thrombus 14 from within blood vessel 12, as shown in
To provide for sufficient expansion of inner sheath 32, at least a portion of inner sheath 32 may be constructed of a suitably resilient material, such as a material having desired shape memory properties. For example, inner sheath 32 may be fabricated at least partially from suitable materials having shape memory properties including, without limitation, Nitinol and other known shape memory alloys (SMA) having properties that develop a shape memory effect (SME), which allows the material to return to an initial configuration after a force or heating process applied to the material to shape, stretch, compress and/or deform the material is removed. In a further embodiment, inner sheath 32 may be fabricated from a thermally treated metal alloy (TMA) including, without limitation, nickel titanium, beta titanium, copper nickel titanium, cobalt chrome, stainless steel, and any combination thereof In an alternative embodiment, inner sheath 32 is expandable using a balloon and/or another mechanism suitable to facilitate expanding inner sheath 32. In a particular embodiment, inner sheath 32 is fabricated at least partially from a suitable polymeric material, such as a polyurethane material. It should be apparent to those skilled in the art that inner sheath 32 may be made or fabricated using any suitable biocompatible material preferably, but not necessarily, having suitable shape memory properties. Further, inner sheath 32 may be made or fabricated using any suitable polymer-coated alloy including, without limitation, a nickel titanium alloy coated with polytetrafluoroethylene (PTFE).
In particular embodiments, inner sheath 32 is made from a mesh material having an outer diameter of about 1 millimeter (mm) to about 30 mm and including one or more wires forming the mesh material. In one particular embodiment, inner sheath 32 includes a mesh material of 24-72 wires each having a diameter of about 10 microns to about 100 microns. The wires may comprise stainless steel, cobalt chrome, nickel titanium, polyester filaments (such as a polymeric expandable monofilament), and suitable combinations thereof The wires may also be coated with PTFE or parylene, for example. In this embodiment, the braiding angle is about 120 degrees and a distance between wires is about 0.05 mm to about 0.5 mm.
In the exemplary embodiment, extraction device 20 includes one or more radio opaque markers located on inner sheath 32 to indicate whether distal end 40 of inner sheath 32 is in a radially expanded configuration. In certain embodiments, two or more markers are positioned about a circumference of inner sheath 32. For example, two markers may be positioned about 180 degrees apart along the circumference of inner sheath 32. As shown, for example, in
Referring further to
In an alternative embodiment, first expandable body 72 includes one or more wire coils or one or more flexible members forming an umbrella-shaped or disc-shaped expandable body (none of which are shown) provided at distal end 78 of catheter 70 that are movable between a collapsed or retracted configuration and a radially expanded configuration. With first expandable body 72 in the expanded configuration, catheter 70 is translated in a proximal axial direction through blood vessel 12 to urge thrombus 14 into inner sheath 32 to facilitate removing thrombus 14 from within blood vessel 12.
In a particular embodiment, as shown in
Referring now to
In the exemplary embodiment, an outer circumference of first expandable body 72 is adjustable to conform to the inner surface of blood vessel 12. Further, first expandable body 72 can be expanded to a specific or desired shape by inflating first balloon 75. In this embodiment, second expandable body 82 is configured to collapse in order to expand first expandable body 72. As second expandable body 82 is collapsed, fluid, such as a suitable gas, is transferred from within second expandable body 82 and/or passage 76 into first expandable body 72 to increase a volume of fluid contained within first expandable body 72 and correspondingly increase the outer circumference of first expandable body 72, as shown in
Referring to
With outer sheath 22 retracted from within blood vessel 12 and removed percutaneously through the incision, catheter 70 is introduced into inner sheath 32 and moved through inner sheath 32 to extend catheter 70 through thrombus 14. With at least distal end portion 78 of catheter 70 extended through thrombus 14, first expandable body 72 positioned at distal end portion 78 of catheter 70 is expanded to move first expandable body 72 radially outward toward the expanded configuration to conform to the inner surface of blood vessel 12. With an outer surface of first expandable body 72 contacting and conforming to the inner surface of blood vessel 12, catheter 70 and expanded first expandable body 72 are retracted into distal end 38 of inner sheath 32 to retain thrombus 14 within inner sheath 32. Thrombus 14 is then removed from within blood vessel 12.
In a particular embodiment, first expandable body 72 positioned at distal end portion 78 of catheter 70 includes first inflatable balloon 75 positioned at distal end portion 78 of catheter 70. Catheter 70 is then moved, with first inflatable balloon 75 inflated, into distal end 38 of inner sheath 32. With thrombus 14 retained with inner sheath 32, first inflatable balloon 75 may be partially deflated to facilitate translating catheter 70 through blood vessel 12 as desired.
In one embodiment, outer sheath 22 is introduced percutaneously into blood vessel 12 proximate thrombus 14. Inner sheath 32 is then inserted into outer sheath 22 and inner sheath 32 in a collapsed or partially collapsed configuration is moved through outer sheath 22 toward thrombus 14. Inner sheath 32 self-expands in a radial direction as inner sheath 32 moves relative to outer sheath 22 and exits distal end 28 of outer sheath 22.
The above-described extraction device can be introduced into a vessel, such as an occluded blood vessel, percutaneously for extracting emboli or thrombi from within the blood vessel. The minimally invasive percutaneous introduction reduces or minimizes trauma to the patient without the need for general anesthesia or hospitalization. In one embodiment, once the inner sheath has been positioned within the outer sheath and proximate the thrombus, the outer sheath can be removed from within the blood vessel to allow the inner sheath to expand in a radial direction substantially along an entire length of the inner sheath to facilitate removal of the thrombus from within the blood vessel. Further, the catheter as described herein includes a first expandable body, such as a first inflatable balloon, positioned distally with respect to the thrombus and a second expandable body, such as a second inflatable balloon, positioned external to the incision that cooperate to transfer fluid into or out of the first expandable body to increase or decrease, respectively, a volume of fluid contained within the first expandable body. This transfer of fluid allows the outer circumference of the first expandable body to be accurately adjusted to conform to the inner surface of the blood vessel without applying an undesired pressure against the blood vessel that may damage the inner surface of the blood vessel or tear or rupture the blood vessel wall.
Exemplary embodiments of a percutaneous thrombus extraction device and methods of utilizing the thrombus extraction device for removing emboli or thrombi from within a blood vessel are described above in detail. The extraction device is not limited to the specific embodiments described herein, but rather, components of the extraction device may be utilized independently and separately from other components described herein. Further, the described extraction device can also be defined in, or used in combination with, other devices and/or methods, and are not limited to practice with only the extraction device as described herein.
This written description uses examples to disclose the disclosure, including the best mode, and also to enable any person skilled in the art to practice the disclosure, including making and using any devices or systems and performing any incorporated methods. The patentable scope of the disclosure is defined by the claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the claims if they have structural elements that do not differ from the literal language of the claims, or if they include equivalent structural elements with insubstantial differences from the literal languages of the claims.
Claims
1. An extraction device for removing a thrombus from within a blood vessel, the extraction device comprising:
- a flexible outer sheath defining a first passage between an outer sheath proximal end and an outer sheath distal end;
- a first inner sheath movable within the first passage, the first inner sheath defining a second passage between a first inner sheath proximal end and a first inner sheath distal end; and
- a catheter movable within the second passage and for extending out of the first inner sheath distal end, the catheter comprising an inner lumen and a plurality of apertures defined through the catheter to provide fluid communication between the inner lumen and the blood vessel, a second inner sheath expandable to contact an inner surface of the blood vessel to draw thrombus into the first inner sheath to facilitate removing the thrombus from the blood vessel.
2. The extraction device of claim 1 wherein the first inner sheath is comprised of a suitable mesh material.
3. The extraction device of claim 1 wherein the second inner sheath is comprised of a suitable mesh material.
4. The extraction device of claim 1, wherein the first inner sheath expands to contact an inner surface of the blood vessel.
5. The extraction device of claim 1 wherein the first inner sheath moves through the outer sheath in a collapsed configuration.
6. The extraction device in accordance with claim 1, wherein the first inner sheath is self-expandable to an expanded configuration to conform to an inner surface of the blood vessel.
7. The extraction device in accordance with claim 1, further comprising a first radio opaque marker located at a first position on a circumferential edge of the distal end of the first inner sheath and a second radio opaque marker located at a second position on the circumferential edge of the distal end of the first inner sheath opposing the first position to indicate whether the distal end of the first inner sheath is in one of an expanded configuration and a convergent configuration.
8. The extraction device in accordance with claim 1, further comprising a source of negative pressure for being applied through the apertures to draw the thrombus into the first inner sheath to facilitate removing the thrombus from the blood vessel.
9. An extraction device for removing a thrombus from within a blood vessel, said extraction device comprising:
- a flexible outer sheath defining a first passage between a proximal end and a distal end;
- a first inner sheath movably positionable within the first passage, the first inner sheath defining a second passage between a proximal end and a distal end, the first inner sheath moveable in a radial direction between a collapsed configuration and an expanded configuration along a length of the first inner sheath defined between the proximal end and the distal end; and
- a catheter movable within the second passage and for extending out of the first inner sheath distal end, the catheter comprising an inner lumen and a plurality of apertures defined through the catheter to provide fluid communication between the inner lumen and the blood vessel, a second inner sheath expandable to contact an inner surface of the blood vessel to draw thrombus into the first inner sheath to facilitate removing the thrombus from the blood vessel.
10. The extraction device in accordance with claim 9, wherein the first inner sheath is self-expandable to the expanded configuration to conform to an inner surface of the blood vessel.
11. The extraction device in accordance with claim 9, wherein, with the first inner sheath extended from the distal end of the outer sheath, the first inner sheath in the expanded configuration contacts an inner surface of the blood vessel.
12. The extraction device in accordance with claim 9, wherein the first inner sheath in the expanded configuration is configured to retain the thrombus to facilitate removal of the thrombus from within the blood vessel.
13. The extraction device in accordance with claim 9, wherein the first inner sheath in the collapsed configuration is movable through the outer sheath.
14. The extraction device in accordance with claim 9, wherein the first inner sheath is comprised of a suitable mesh material.
15. The extraction device of claim 9, wherein the second inner sheath is comprised of a suitable mesh material.
16. The extraction device in accordance with claim 9, further comprising a first radio opaque marker located at a first position on a circumferential edge of the distal end of the first inner sheath and a second radio opaque marker located at a second position on the circumferential edge of the distal end of the first inner sheath opposing the first position to indicate whether the distal end of the first inner sheath is in one of an expanded configuration and a convergent configuration.
17. The extraction device in accordance with claim 9, further comprising a source of negative pressure for being applied through the apertures to draw the thrombus into the first inner sheath to facilitate removing the thrombus from the blood vessel and/or to aspirate the thrombus into the first inner sheath.
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Type: Grant
Filed: Feb 10, 2020
Date of Patent: Feb 7, 2023
Patent Publication Number: 20200170656
Inventor: Gil Vardi (St. Louis, MO)
Primary Examiner: Tuan V Nguyen
Application Number: 16/786,750
International Classification: A61B 17/22 (20060101); A61B 17/221 (20060101);